Provider Demographics
NPI:1699737106
Name:HOLMES, LAWRENCE A (PT, CHT)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:HOLMES
Suffix:
Gender:M
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5779 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4011
Mailing Address - Country:US
Mailing Address - Phone:423-800-7500
Mailing Address - Fax:
Practice Address - Street 1:5779 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-4011
Practice Address - Country:US
Practice Address - Phone:423-800-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0138172251H1200X
TN00000098172251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000477214OtherBCBS FACET #
KY000000477214OtherBCBS FACET #